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Narayan P, Doddamane AN, Bryan AJ. Moderately dilated ascending aorta-The right wrap? J Card Surg 2022; 37:927-929. [PMID: 35083788 DOI: 10.1111/jocs.16274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/18/2022] [Indexed: 11/26/2022]
Abstract
External reinforcement of the dilated or thin-walled aorta has been tried for nearly half a century. A range of materials has been used as external support. This commentary assesses the evidence that exists regarding the efficacy of wrapping the aorta as well as compares the different options available with a particular focus on the usage of the autologous pericardium.
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Affiliation(s)
- Pradeep Narayan
- NH Rabindranath Tagore International Institute of Cardiac Sciences, Kolkata, West Bengal, India
| | - Aditya N Doddamane
- Sri Sathya Sai Institute of Higher Medical Sciences, Bengaluru, Karnataka, India
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Kim HH, Joo HC. Reply: Main factor in distal aorta dilatation after wrapping: Procedure rather than material. J Thorac Cardiovasc Surg 2021; 164:e78-e79. [PMID: 33985804 DOI: 10.1016/j.jtcvs.2021.03.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/31/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Hyo-Hyun Kim
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Chel Joo
- Division of Cardiovascular Surgery, Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
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Orozco-Sevilla V, Salerno TA. Commentary: Wrap one's aorta around. J Thorac Cardiovasc Surg 2021; 164:476-477. [PMID: 33934898 DOI: 10.1016/j.jtcvs.2021.03.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Vicente Orozco-Sevilla
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Section of Adult Cardiac Surgery, Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex; CHI St Luke's Health-Baylor St Luke's Medical Center, Houston, Tex
| | - Tomas A Salerno
- Division of Cardiothoracic Surgery, Miller School of Medicine, University of Miami and Jackson Memorial Hospital, Miami, Fla.
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Plonek T, Rylski B, Nawrocki P, Beyersdorf F, Jasinski M, Kuliczkowski W. Systolic stretching of the ascending aorta. Arch Med Sci 2021; 17:25-30. [PMID: 33488852 PMCID: PMC7811307 DOI: 10.5114/aoms.2019.82997] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 11/08/2017] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Longitudinal stretching of the aorta due to systolic heart motion contributes to the stress in the wall of the ascending aorta. The objective of this study was to assess longitudinal systolic stretching of the aorta and its correlation with the diameters of the ascending aorta and the aortic root. MATERIAL AND METHODS Aortographies of 122 patients were analyzed. The longitudinal systolic stretching of the aorta caused by the contraction of the heart during systole and the maximum dimensions of the aortic root and ascending aorta were measured in all patients. RESULTS The maximum dimension of the aortic root was on average 34.9 ±4.5 mm and the mean diameter of the ascending aorta was 33.9 ±5.4 mm. The systolic aortic stretching negatively correlated with age (r = -0.49, p < 0.001) and the diameter of the tubular ascending aorta (r = -0.44, p < 0.001). There was no significant correlation between the stretching and the dimension of the aortic root (r = -0.11, p = 0.239). There was a statistically significant (p < 0.001) difference in the longitudinal aortic stretching values between patients with a normal aortic valve (10.6 ±3.1 mm) and an aortic valve pathology (8.0 ±3.2 mm in all patients with an aortic valve pathology; 7.5 ±4.3 mm in isolated aortic stenosis, 8.5 ±2.9 mm in the case of isolated insufficiency, 8.2 ±2.8 mm for valves that were both stenotic and insufficient). CONCLUSIONS Systolic aortic stretching negatively correlates with the diameter of the tubular ascending aorta and the age of the patients, and does not correlate with the diameter of the aortic root. It is lower in patients with an aortic valve pathology.
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Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Pawel Nawrocki
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Friedhelm Beyersdorf
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
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Gamel AE. Ascending Aortic Aneurysm Wrapping: The Renaissance of an Old Technique. Heart Lung Circ 2019; 28:1770-1772. [PMID: 31813480 DOI: 10.1016/j.hlc.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Adam El Gamel
- Waikato Cardiothoracic Unit, Waikato Hospital, Hamilton, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand; University of Waikato Medical Research Centre, The University of Waikato, New Zealand.
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Kolvenbach R, Karmeli R, Rabin A, Lica R. Endovascular Hybrid Repair of True Ascending Aortic Aneurysms Using Double Graft Wrapping to Prepare a Landing Zone for Ascending Aortic Stent-Graft Placement: A Cohort Study. J Endovasc Ther 2019; 26:658-664. [PMID: 31198085 DOI: 10.1177/1526602819856075] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To describe a hybrid procedure that avoids cardiopulmonary bypass to treat patients with true ascending aortic aneurysms without a suitable proximal landing zone for endovascular repair. Material and Methods: Thirteen consecutive patients (mean age 75.9±6.5 years; 8 women) with true ascending aortic aneurysms were treated with the endovascular hybrid repair of true aortic aneurysms (EHTA) approach, which consists of a conventional sternotomy with double wrapping of the ascending aorta followed by staged stent-graft placement. Via sternotomy, a polypropylene mesh trimmed to downsize the aneurysm is placed around the dilated ascending aorta and sutured to the adventitia. A similarly trimmed polytetrafluoroethylene graft is placed loosely around the first wrap to avoid adhesions and secure the proximal landing zone. There is no need for cardiopulmonary bypass. A few days later, a standard thoracic stent-graft is deployed via either a transaxillary or transfemoral access; chimney or bypass grafts are used as needed to revascularize the supra-aortic vessels. Results: The ascending aortic diameter was reduced from a mean 5.7 cm (range 4.8-6.5) to 3.9 cm (range 3.2-4.3) after wrapping. The mean interval between surgery and stent-graft placement was 5 days. In this interval, 2 patients with significant reduction in the diameter of the ascending aorta elected to forego placement of a stent-graft. Of the 11 patients who underwent the full hybrid EHTA procedure, the ascending aortic stent-graft was combined with a chimney graft in the innominate artery in 4 cases. In 1 patient, a supra-aortic debranching procedure using a bifurcated Dacron graft to the innominate and left common carotid arteries was performed after wrapping with the polypropylene mesh. There was no mortality or neurological complication. A sternal wound infection required a prolonged hospital stay. At a mean follow-up of 13.8 months (range 3-24), there has been no death, type I endoleak, or sign of aneurysm enlargement on imaging. Conclusion: This technique permits complete endovascular exclusion of an ascending aortic aneurysm in a less invasive approach than standard open repair. Although this is only a small cohort of patients without long-term follow-up, it seems that this hybrid procedure is associated with low morbidity and mortality. It offers a beating-heart approach to treat true ascending aortic aneurysms in selected high-risk patients.
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Affiliation(s)
- Ralf Kolvenbach
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital, Catholic Hospital Group, Düsseldorf, Germany
| | | | | | - Raluca Lica
- Department of Vascular Surgery and Endovascular Therapy, Augusta Hospital, Catholic Hospital Group, Düsseldorf, Germany
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Hsu HL, Huang CY, Chen PL, Chen YY, Hsu CP, Chen IM, Shih CC. Efficacy of ascending aortic banding technique concomitant with type I hybrid aortic arch repair in high-risk patients. Heart Vessels 2019; 34:1524-1532. [PMID: 30911784 DOI: 10.1007/s00380-019-01384-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 03/15/2019] [Indexed: 11/26/2022]
Abstract
Banding of the ascending aorta has been introduced as a less complex procedure to optimize the proximal landing zone of the stent graft in hybrid aortic arch surgery. However, data about the long-term results and effects of this technique are still limited. We aimed to study the efficacy of banding of the ascending aorta in hybrid aortic arch repair. The study included 11 high-risk patients with dilated ascending aorta (wider than 38 mm in diameter) undergoing ascending aortic banding for hybrid arch repair. Clinical outcomes, including technical success, endoleaks, perioperative mortality and morbidity, and sequential remodeling of the ascending aorta were investigated. The average diameter of the ascending aorta had been reduced (p = 0.02) from 42.1 mm (range = 39.0-46.4) to 37.2 mm (range = 35.6-38.6) after banding procedure. The technical success rate was 100.0%. No type I endoleak occurred, but 2 cases of distal stent graft-induced new entry required re-interventions. The 5-year survival and freedom from aortic events rates both were 81.8%. The ascending aortic diameter remained stable and no proximal migration of the stent graft was observed during the study period. The 5-year results validated the durability of this therapeutic modality, especially in high-risk patients.
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Affiliation(s)
- Hung-Lung Hsu
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Cardiovascular Surgery, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chun-Yang Huang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Po-Lin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Yin-Yin Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Surgery, Taiwan Adventist Hospital, Taipei, Taiwan
| | - Chiao-Po Hsu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - I-Ming Chen
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan
| | - Chun-Che Shih
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, #201, Section 2, Shipai Road, Taipei, Taiwan.
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Kocica MJ, Karadzic MM, Cvetkovic DD, Grujic MB, Soskic L. Off-Pump Plicating Ascending Aortoplasty With External Wrapping: Magnum in Parvo. Heart Lung Circ 2018; 28:1866-1871. [PMID: 30424984 DOI: 10.1016/j.hlc.2018.10.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/19/2018] [Accepted: 10/21/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND Isolated, fusiform aneurysms, exclusively affecting the tubular portion of the ascending aorta, are rare. Surgical treatment aims to change their natural course, reducing individual and cumulative risks of rupture, dissection and death. Open tubular graft replacement still remains the procedure of choice, despite significant risks. In permanent pursuit for optimal, alternative surgical strategy in high-risk patients, less invasive and off-pump plicating ascending aortoplasty with modified external Dacron graft wrapping seems to be a reliable choice. METHODS Two (2) consecutive patients were operated on. The same preoperative calculations and slightly different operative techniques were applied regarding surgical exposure and wrapping graft orientation. Immediate and late follow-up (5 years) results were compared. RESULTS Absolute and indexed target ascending aortic diameters remained acceptable (<2.1cm/m2 considered the upper normal range for adults). There were no significant changes in proximal and distal aortic diameters. Ascending aortic silhouette on contrast enhanced multi-detector CT was better with Dacron wrapping graft tailored to have its grooves in the longitudinal direction. Upper mini-sternotomy was quite appropriate for this procedure, from a surgical point of view, and was safe for the patient. CONCLUSIONS Careful patient selection and using the current model of preoperative calculations and surgical technique resulted in acceptable and stable ascending aortoplasty in high-risk patients 5 years after surgery.
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Affiliation(s)
- Mladen J Kocica
- UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia.
| | - Milica M Karadzic
- UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
| | - Dragan D Cvetkovic
- UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
| | - Milos B Grujic
- UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
| | - Ljiljana Soskic
- UC Clinical Centre of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
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Plonek T, Zak M, Rylski B, Berezowski M, Czerny M, Beyersdorf F, Jasinski M, Filipiak J. Wall stress correlates with intimal entry tear localization in Type A aortic dissection†. Interact Cardiovasc Thorac Surg 2018; 27:797-801. [DOI: 10.1093/icvts/ivy158] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 04/10/2018] [Indexed: 01/12/2023] Open
Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Malgorzata Zak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Mikolaj Berezowski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Martin Czerny
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Faculty of Medicine, Heart Centre Freiburg University, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland
| | - Jaroslaw Filipiak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
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10
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Surgical treatment with wrapping of the moderately-dilated ascending aorta. TURK GOGUS KALP DAMAR CERRAHISI DERGISI-TURKISH JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2018; 26:192-199. [PMID: 32082734 DOI: 10.5606/tgkdc.dergisi.2018.14988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/02/2017] [Indexed: 11/21/2022]
Abstract
Background The aim of this study is to present early and mid results associated with the treatment of dilatation of the ascending aorta using the wrapping technique. Methods A total of 54 patients (16 males, 38 females; mean age 56.9±12.7 years; range 21 to 77 years) who were subjected to the wrapping technique due to dilatation of the ascending aorta between January 2010 and Fabruary 2017 were retrospectively analyzed. The Dacron grafts were used in all patients. Wrapping was performed in all patients in combination with the other cardiac surgical procedures. Wrapping was performed with aortoplasty in 32 patients and as an isolated procedure in 22 patients. Preoperative clinical findings, concomitant cardiac procedures, intraoperative parameters, postoperative early and long-term outcomes were evaluated. The ascending aorta and descending aorta diameters, ejection fraction, left ventricle end-diastolic and end-systolic diameters were measured using a computed tomography scan and/or transthoracic echocardiography after surgery, and was compared with the preoperative values. Results The median follow-up was 3.8 (range, 1 to 7) years. No intraoperative complication associated with the wrapping procedure was reported in any of the patients. One patient died during the early postoperative period. Relapse-free intra-arterial fibrinolysis was used to correct postoperative cerebral infarct in one patient without any sequelae. Revision surgery was required in two patients due to bleeding and in another two patients due to sternal dehiscence. A postoperative decrease in the aortic diameter and an increase in the ejection fraction were found to be statistically significant. Findings such as sinus of Valsalva and distal aortic dilation, rupture, pseudoaneurysm, and graft mobilization were not observed during follow-up. Conclusion Our study results show that the wrapping techniques may be safely performed in patients with moderate dilatation of the aorta who do not require replacement of the ascending aorta.
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Plonek T, Zak M, Burzynska K, Rylski B, Gozdzik A, Kustrzycki W, Beyersdorf F, Jasinski M, Filipiak J. The combined impact of mechanical factors on the wall stress of the human ascending aorta - a finite elements study. BMC Cardiovasc Disord 2017; 17:297. [PMID: 29262774 PMCID: PMC5738844 DOI: 10.1186/s12872-017-0733-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 12/11/2017] [Indexed: 01/16/2023] Open
Affiliation(s)
- Tomasz Plonek
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Malgorzata Zak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Karolina Burzynska
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
| | - Bartosz Rylski
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Anna Gozdzik
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Wojciech Kustrzycki
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Friedhelm Beyersdorf
- Department of Cardio-vascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Marek Jasinski
- Department of Cardiac and Thoracic Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Jaroslaw Filipiak
- Department of Biomedical Engineering, Mechatronics and Theory of Mechanisms, Wroclaw University of Science and Technology, Wroclaw, Poland
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12
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González-Santos JM, Arnáiz-García ME. Wrapping of the ascending aorta revisited-is there any role left for conservative treatment of ascending aortic aneurysm? J Thorac Dis 2017; 9:S488-S497. [PMID: 28616345 DOI: 10.21037/jtd.2017.04.57] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Dilatation of the ascending aorta (AA) is a common finding in patients with aortic valve disease. The clinical practice guidelines recommend replacing the AA whenever the diameter exceeds 45 mm. However, no consensus has been reached regarding the approach when the aorta is only moderately dilated. Although the risk in aorta replacement is generally low, it may be higher when associated with other complex surgical procedures or it is carried out in elderly patients or patients with significant comorbidity. This would justify the use of alternative surgical techniques, which reduce surgical risk and guarantee a durable correction of the aortic pathology. Conservative treatment of aneurysms of the AA via wrapping with different synthetic materials has been implemented for many years. The most commonly used technical variant is wrapping the dilated aorta with a vascular prosthesis with a predetermined diameter. When this technique is adequately applied, it immediately reduces the diameter of the AA and, to a lesser degree, the diameter of the aortic root and arch, while at the same time it reinforces the weak aortic wall. These effects lead to a drop-in wall shear stress and in the risk of aortic dissection and rupture, and persist over time. Although the low elasticity of the external support causes significant changes in the histologic structure of the aortic wall, mainly atrophy and alterations typical of a foreign body-induced reaction, this does not seem to involve a higher risk of complications. In some selected patients, this technique may be used in cases other than post-stenotic aortopathy, and also in aortas with a larger diameter.
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Van Hoof L, Verbrugghe P, Verbeken E, Treasure T, Famaey N, Meuris B, Herijgers P, Rega F. Support of the aortic wall: a histological study in sheep comparing a macroporous mesh with low-porosity vascular graft of the same polyethylene terephthalate material. Interact Cardiovasc Thorac Surg 2017; 25:89-95. [DOI: 10.1093/icvts/ivx009] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/03/2017] [Indexed: 11/14/2022] Open
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Biomechanics of the Thoracic Aorta: Complexity and Reliability. Ann Thorac Surg 2016; 102:1028. [PMID: 27549527 DOI: 10.1016/j.athoracsur.2016.01.108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 11/21/2022]
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15
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Treasure T. A 'compare and contrast' exercise: wrapping versus personalised external aortic root support (PEARS). J Cardiothorac Surg 2016; 11:104. [PMID: 27406033 PMCID: PMC4942886 DOI: 10.1186/s13019-016-0499-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
Wrapping of the aorta and personalised external aortic root support (PEARS) both have the purpose of preventing further expansion of the ascending aorta in order to reduce the risk of aortic dissection and to spare the patient the disastrous consequences of aortic rupture. For the first time, Plonek and colleagues have reported systematically the CT appearances of a series of cases of wrapping. They illustrate the important finding that there are residual spaces between the aorta and the wrap. PEARS by contrast is intimately in contact with the aorta due to its personalised design and is fully incorporated due it construction from a porous mesh. A limitation of PEARS is that it is, of its nature, a planned and elective operation while wrapping can be undertaken during an emergency operation and can be used without prior planning as an intraoperative decision.
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Affiliation(s)
- Tom Treasure
- Clinical Operational Research Unit, University College London, London, UK.
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16
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Płonek T, Dumanski A, Nowicki R, Kustrzycki W. Computed tomography angiography of aorta subjected to external wrapping. J Cardiothorac Surg 2016; 11:89. [PMID: 27245321 PMCID: PMC4888732 DOI: 10.1186/s13019-016-0487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Accepted: 05/25/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND External wrapping is a surgical technique used in patients with dilated ascending aorta. To date, there is no available data describing the radiographic features of the aorta subjected to external wrapping using a straight corrugated Dacron vascular prosthesis. The aim of this study was to find distinctive radiographic features of an externally constricted aorta. METHODS Preoperative and early postoperative (7th postoperative day) CT angiography images of ten patients who underwent wrapping procedures were assessed and compared. The images were analyzed in order to find characteristic features of CT angiography images of the ascending aorta subjected to external wrapping. RESULTS The CT-angiography images showed that the aortic wall deformed significantly (the wall plicated) after the wrapping procedure in one patient, whose aortic diameter was decreased by 47 %. The remaining nine patients did not have significant aortic wall deformations. All patients presented with a periaortic mass. This was a collection of blood clots and pericardial fluid that filled the empty space in the pericardium following a decrease in the diameter of the ascending aorta. A very thin (<1 mm) crescent-shaped uncontrasted layer was noticed between the aorta and the periaortic area in all patients. This, in turn, was an empty space between the aorta and the corrugated vascular prosthesis. CONCLUSIONS The CT-angiography images of the aorta subjected to external wrapping may have unique features that are not observed after other operations on the ascending aorta. The knowledge about the details of this surgical procedure helps to correctly assess these images.
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Affiliation(s)
- Tomasz Płonek
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Andrzej Dumanski
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Rafal Nowicki
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
| | - Wojciech Kustrzycki
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland
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Pecoraro F, Shingaki M, Steuer J, Chaykovska L, Rancic Z, Weber A, Nguyen-Kim TDL, Bettex D, Veith FJ, Lachat M. Treatment of isolated ascending aortic aneurysm by off-pump epiaortic wrapping is safe and durable. Interact Cardiovasc Thorac Surg 2016; 23:286-91. [PMID: 27083869 DOI: 10.1093/icvts/ivw103] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 03/08/2016] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Isolated ascending aortic aneurysm (iAA) is usually treated by open graft repair requiring sternotomy, cardiopulmonary bypass (CPB) and cardioplegia. This approach carries significant mortality in older patients or those presenting with comorbidities. We report an original series of patients presenting with iAA and treated with epiaortic wrapping by using a synthetic mesh. This less invasive aortic repair technique allows reducing the aortic diameter to a predefined value and is performed without CPB. METHODS Data from patients presenting with an iAA and treated with the wrapping technique (WT) by polypropylene/polyester mesh from November 2006 to July 2015 were collected. The end-points that were analysed included maximal aortic transverse diameter, perioperative mortality and morbidity, survival, freedom from reinterventions and aortic valve function during follow-up. The maximal aneurysm transverse diameter was analysed based on contrast-enhanced computed tomography (CTA) or magnetic resonance (MR) performed preoperatively, and during the follow-up. RESULTS The off-pump WT was used in 33 cases with no perioperative mortality. The median radiological follow-up was 33.47 (range: 1-106) months. Overall, the WT achieved a 30% diameter reduction. The mean preoperative and postoperative ascending aortic transverse diameter was 5.5 cm [standard deviation (SD): 0.6] and 3.7 cm (SD: 0.30), respectively (P = 0.001). In addition, CTA or MR follow-up showed stable diameters at the level of the aortic root and the distal ascending aorta. No death occurred during the follow-up. At 5 years, the estimated freedom rate from reinterventions of the aortic root and ascending aorta was 94%. CONCLUSIONS This series shows that the WT with a polypropylene/polyester mesh allows safe off-pump treatment of patients with iAA. Mid- and long-term results are promising. This technique could be an attractive alternative, especially for patients unfit for aortic surgery with CPB and cardioplegia.
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Affiliation(s)
- Felice Pecoraro
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Masami Shingaki
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Johnny Steuer
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Lyubov Chaykovska
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Zoran Rancic
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Alberto Weber
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | | | - Dominique Bettex
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Frank J Veith
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
| | - Mario Lachat
- Clinic for Cardiovascular Surgery, University Hospital Zurich, Zurich, Switzerland
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Plonek T, Dumanski A, Nowicki R, Kustrzycki W. Single center experience with wrapping of the dilated ascending aorta. J Cardiothorac Surg 2015; 10:168. [PMID: 26589143 PMCID: PMC4654867 DOI: 10.1186/s13019-015-0371-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 10/28/2015] [Indexed: 01/16/2023] Open
Abstract
Background External wrapping is a surgical technique performed in patients with a dilated ascending aorta. The aim of this study is to present the mid-term results of wrapping of the dilated ascending aorta. Methods 34 patients (mean age: 64.4 ± 10.8 years, 21 males) with a dilated ascending aorta were operated on at a single cardiac surgery center using a wrapping technique. The aortas were wrapped with 32–36 mm straight Dacron vascular prostheses. The aortic wall was not excised in any of the patients. Wrapping was performed concomitant to other cardiac surgery procedures in 30 patients (88 %), which involved surgery on the aortic valve in 28 patients (82 %). Results The mean follow-up time was 19.5 ± 8.3 months (median: 18 months, range: 12–36 months). None of the patients died or had aortic complications during the hospital stay and the follow-up period. A rethoracotomy had to be performed due to excessive postoperative bleeding in two patients. One patient was diagnosed with a transient ischemic attack on the 4th postoperative day, while another had respiratory failure requiring prolonged intubation. No redilatation of the ascending aorta or dislocation of the wrap was noticed in any of the patients. Conclusions According to our study, external wrapping of the ascending aorta has good short-term results and may be regarded as a safe surgical option for patients with a moderately dilated ascending aorta.
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Affiliation(s)
- Tomasz Plonek
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Andrzej Dumanski
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Rafal Nowicki
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
| | - Wojciech Kustrzycki
- Department of Cardiac Surgery, Wroclaw Medical University, Borowska 213, 50-556, Wroclaw, Poland.
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